The presentation, clinical features, complications, and treatment of congenital dacryocystocele

Abstract

PurposeTo determine the incidence and presenting features of congenital dacryocystocele in the United Kingdom. To report on those cases complicated by dacryocystitis, respiratory compromise, and the treatment undertaken.MethodsA prospective observational study of cases of congenital dacryocystocele presenting in the United Kingdom between September 2014 and October 2015. Infants <3 months of age presenting with a cystic swelling in the medial canthal area were included. Cases were identified via the British Ophthalmology Surveillance Unit (BOSU) reporting system.ResultsA total of 49 cases were reported during the study period. This gives an incidence of 1 in 18 597 live births. There was a 71% response rate to the questionnaire. The average age at presentation was 16.94 days. Dacryocystoceles were unilateral in 91% of cases. Dacryocystitis was a complicating factor in 49% of patients and 17% had respiratory distress. Uncomplicated dacryocystocele responded well to conservative measures in 86%. Surgical intervention was required in 23% of patients. Those cases complicated by dacryocystitis (29%) and nasal obstruction (17%) were more likely to require surgical intervention compared to those with dacryocystocele alone (14%). Digital massage appears to reduce the likelihood of requiring surgical intervention. The mean time to resolution was 19 days.ConclusionsCongenital dacryocystocele is a rare presentation in the United Kingdom. Dacryocystitis and respiratory compromise commonly complicate a dacryocystocele. The use of digital massage as an early intervention is advocated and conservative measures may be sufficient in cases of uncomplicated dacryocystocele.

Comparison of marsupialization under nasal endoscopy versus lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases

“…When a congenital dacryocystocele forms, spontaneous regression of >50% of the congenital dacryocystocele occurs within 3 months, >80% occurs within 6 months, and 95% occurs within 1 year [7]. Approximately 76% of children can reportedly be cured with nonsurgical treatment, including lacrimal sac massage, lacrimal duct irrigation, and other conservative treatments [8,9]. However, the disease is easily complicated by dacryocystitis or periorbital cellulitis; thus, early intervention is required.…”

Comparison of marsupialization under nasal endoscopy versus Lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases

“…When a congenital dacryocystocele forms, spontaneous regression of >50% of the congenital dacryocystocele occurs within 3 months, >80% in 6 months, and 95% at 1 year [7]. Approximately 76% of children can reportedly be cured after nonsurgical treatment, including lacrimal sac massage, lacrimal duct irrigation, and other conservative treatment [8,9]. However, the disease is easily complicated by dacryocystitis or periorbital cellulitis; thus, early intervention is required.…”

Focal epilepsy as a late complication of congenital dacryocystocele

“…Congenital dacryocystoceles (previously referred to as, mucocele, or amniotocele) [1] are ectatic lacrimal sac cysts caused by obstruction of both of the outflow pathways, the proximal valve of Rosenmuller, and the distal valve of Hasner [2,3]. Congenital dacryocystocele is a rare condition, distinguished from the common causes of nasolacrimal duct obstruction by the cyst formation.…”

“…Early recognition and treatment of congenital dacryocystocele can prevent the recognised complications of respiratory compromise in neonates, infection, orbital displacement and astigmatism. The use of gentle digital massage as an early intervention in the neonatal period is advocated, and conservative measures may be sufficient in cases of uncomplicated dacryocystocele in 60% of cases [2,3]. T ethmoidal cells [2,3].…”